I usually have one day a month that’s jam-packed with medical appointments, to the exclusion of all else, and that was Tuesday last. I started off at the dentist’s, where my mouth was judged ready for impressions and crafting of a Permanent Crown!
Next stop: Nurse Nycta for the monthly check-in and psych drugs. We reviewed all things and decided to reduce Lamictal again, this time to 50 mg, and in 2 weeks, 25mg. I felt pretty certain that mood symptoms are aligned with hormonal problems, which the mood stabilizer can’t touch. But she’s as concerned as I about some details the endocrinologist really hasn’t adequately verified, tested, or ruled out.
I mentioned recent heart palpitations; she immediately ordered an EKG, concerned about heart complications from Yaz. The next day, I noted down times when I felt my heart racing, and wouldn’t you know, the palpitations appeared and were most frequent during peak serum level timing, 1-2 hours after dosing. A couple days later, on the placebo pills – no heart palpitations. Can you see where this is going to go?
Nycta also ordered every blood test under the sun, including potassium (part of the heart risk equation), lipids, and all the stuff I really do need checked a couple times a year. Plus all the hormone levels, again.
Third stop: Hippie Dude. By then, I was mostly just worrying about the next appointment and fretting about how bad things had been the week before. I hardly remember what we discussed, other than feeling overwhelmed and anxious about what will happen next. Not the most productive session ever.
Fourth stop: the Reproductive Endocrinologist. The nurse asked me what brought me in, so I mentioned diagnostic questions, concern over lack of any relief, and next steps in treatment when Yaz inevitably fails. When I went in to the endo and tried to go through the same list, he shot me down on point after point. Endometriosis? No, doesn’t cause PMDD (I didn’t say it did) or cyclic symptoms (have you empirically verified the cyclic nature of my symptoms? No?) Perimenopause? No, my periods weren’t irregular before birth control pills and hormone levels appear normal enough to a cursory review (but no one has asked about other qualitative changes, e.g. to duration and flow.)
But nothing is improving, I said, and this is beyond unbearable. So he spent some time berating me for complaining after only 2 months, when I should expect to wait 4-6 months to stabilize on Yaz. It turns out that the only reasons he prescribed Yaz were because it’s FDA approved for PMDD (big fucking deal) and because it has only 4 days of placebos. So if fewer placebo days is what will stabilize things, then I should just skip the placebos, right? No, he says, take the damn placebos. WTF?!?
The next option, since I don’t want to try Lupron, is Danazol. I’m not going to get into the details of why those are scary options, but they are scary. Lupron and Danazol shut down the ovaries completely, so you can imagine the kinds of side effects that entails (chemical menopause, basically.)
OK, so I understand that I should give the Yaz another 2 months. But what about these heart palpitations? He tells me it’s caffeine. How is that possible, I asked, after just one cup of coffee in the morning, same as it’s been for years? That makes no sense. It’s all stress, he says, changing his tune. Again, while I’ve been pretty stressed recently, it’s hardly a change from the status quo. The only thing that has changed recently is Yaz, which is known to cause heart problems. On the drug information insert, you’re instructed to immediately get an EKG if you experience arrhythmia – but my Department Chair Reproductive Endocrinologist knows better than the people who got their pants sued off to ensure that the heart risk warning is included on the patient information sheet. Uh-huh.
During the entire 10 minute appointment, I felt belittled and insulted over and over. The nurse looked uncomfortable – as the doctor dressed me down, she wouldn’t look at me. The student/intern/white coat who was observing looked bored. I mean, the collective body language was just insane – it said, “you’re wasting our time, crazy woman” in no uncertain terms. I tried to stand up for myself and felt like an idiot for it because the doctor just insulted me further. So much for being assertive.
This is by-the-book treatment based on half-assed diagnostic work. I know it’s the standard treatment because I can read WebMD, and any other OB/GYN would also be able to follow the step-by-step algorithm to hormonal obliteration. Or better yet, an NP could do it, probably without being a jerk. The only reason to see a pompous expensive asshole of an endocrinologist is for greater expertise and more options for treating severe cases, and hopefully superior diagnostic expertise as well. FAIL.
So what comes next? Good question; that’s a post for another day. Suffice it to say, though, that this dead end is the end o’ the endo, as far as I’m concerned.